Provider Demographics
NPI:1265894919
Name:IDUMWONYI, EGHOSA ROSEMARY (MD)
Entity type:Individual
Prefix:
First Name:EGHOSA
Middle Name:ROSEMARY
Last Name:IDUMWONYI
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:EGHOSA
Other - Middle Name:
Other - Last Name:IDUMWONYI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:18 W TREMLETT ST APT 2
Mailing Address - Street 2:
Mailing Address - City:DORCHESTER
Mailing Address - State:MA
Mailing Address - Zip Code:02124-2018
Mailing Address - Country:US
Mailing Address - Phone:617-602-6451
Mailing Address - Fax:
Practice Address - Street 1:800 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:NORWOOD
Practice Address - State:MA
Practice Address - Zip Code:02062-3487
Practice Address - Country:US
Practice Address - Phone:781-769-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2025-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA279081207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty